Prostate Cancer, Bob Sierra, Technician discussed on The Peter Attia Drive
I'm sure have different versions. But even from a screening standpoint that they could be you'd have one tool that is so good in both yet. There is fortuitous. Yeah, they're good tools. And then so after if there's an abnormality in the P H I R four K score. Then I moved to an MRI. And then there's been good day. Can you just because I mean, we talk we geek out on this stuff because I'm super nerdy about what type of MRI to do for what thing, but for a patient listening to this Ted who's going to go to their doctor, and whose doctor is hopefully cooperative enough. What do you recommend because not all Emmys doing the trick here? Yeah. I mean on paper what you want a multi parametric prostate MRI, the most important phase the most important parameter in the multi parametric MRI is actually the diffusion weighted imaging which is the most operators dependent. So it really requires a skilled technician and escape. Killed interpreter. Radiologist to look at those DWI images, that's the most important one. So we do get patients contrast. But people showing you can get a lot of value out of just non contrast DWI based the one we use. No contrast, but it's their DWI's exceptional. I've sent you the images I think if they're Schaefer approved I'm happy. They're very good. Yeah. T one t two DWI an multiplayer MR is if you're listening to that. And if you and if your doctor refuses that I think those are the kinds of things that make me think you need another doctor because at this point and look your insurance might not cover. You may have to foot the Bill for that. And that's that's horrible. Well, wouldn't cover that? That was true. But there's recently reported a large multinational prospective clinical trial, looking at the utility of Mariah used for screening for prostate cancer. And the study was half the men got an MRI of their suspicious lesion. They got that lesion biopsy. And they increase detection of high grade cancer reduce it over. Detection of low grade prostate cancer. So it was a quote, unquote, positive study. We haven't had problems in the mid west Illinois getting 'em is approved. But that randomized trial based out of reported out of the UK that really has changed a lot about what companies are approving for Moore is for screening so rate to here. So so if somebody has an MRI if there's an Adra malady on the MRI, I'll recommend a biopsy. Now, there's a lot of data that says you shouldn't just sample the suspicious lesion that you should do the suspicious lesion plus doing a Sexton. Bob Sierra, kind of what I tell patients is right left top middle bottom that adds value. Not just in the detection of cancer. But if someone is gonna move to surgery, for example, and I don't do a biopsy in ninety year old guy. Even if they have an abnormal Marai, do it. If I think that person's gonna live a long long enough to benefit from treatment in those scenarios. I do those systematic by because I want to know exactly where the extent of the cancer and one of the problems of them arise it it doesn't. Actually, see the true boundaries are true. Borders of the tumors within the prostate, very well. So they're often especially the DWI because it's not really an anatomic. Yes. The way a t one way to images traffic. So if you take if you take the lesion on T to for example, it often under sizes the tumor by between five and ten millimeters. So pretty significant for prostate, which is generally pretty small. So so I do those to get a better roadmap..